1417152570 NPI number — NOVATO HEALTHCARE CENTER, LLC

Table of content: (NPI 1417152570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417152570 NPI number — NOVATO HEALTHCARE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOVATO HEALTHCARE CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NOVATO HEALTHCARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417152570
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1565 HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOVATO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94947-4063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-634-1940
Provider Business Mailing Address Fax Number:
323-634-1943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1565 HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOVATO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94947-4063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-897-6161
Provider Business Practice Location Address Fax Number:
415-898-0561
Provider Enumeration Date:
06/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RECHNITZ
Authorized Official First Name:
SHLOMO
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
626-800-1191

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LTC90087F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com